Infant mortality in a host of newborn gastrointestinal disturbances is often primarily related to the effects of starvation. For many years, investigators sought to develop an artificial method for delivering the nutrients necessary for heatling with normal growth and development, but such attempts generally failed. However, in 1967 several investigators reported a new technique which allowed prolonged hypertonic intravenous alimentation with resultant normal growth and development in puppies. Since then, this method has been utilized successfully in adults, children, and infants. This technique involves inserting a catheter into an appropriate vein and delivering a specially prepared infusate to the patient through the catheter.
In the case of infants, the catheter is ordinarily inserted in the operating room under the usual sterile techniques using local anesthesia. A transverse incision is made over the right sternocleidomastoid muscle, and after isolation of the external jugular vein, the catheter is intoduced and advanced to the desired point, its precise location being confirmed by x-ray study. The free end of the catheter is then placed under the skin at the incision and brought out some distance away behind the right ear in a subcutaneous location using a large bore hollow needle to facilitate the passage of the catheter beneath the skin. The incision is closed and antibiotic ointment and a dressing are applied to the exit point of the catheter after it has been secured in place with a silk suture with great care being taken to maintain the sterility of the exit site of the catheter. Conventional types of intravenous tubing are then attached to the free end of the catheter and the infusate is introduced into the patient using an infusion pump or the like.
In the case of infants, it is essential to have proper positioning of the catheter since improper positioning of the catheter can be responsible not only for complications but also for death in infants. Thus, X-ray control in the placing of the catheter in the operating room at the time of the initial placement is generally considered to be necessary.
It has been noted that infants (particularly newborns) engage in random, uncontrolled movement and great care must be taken to protect the catheter where it exits from the patient so that the catheter is not dislodged. Various techniques have been tried for anchoring the catheter at its exit site behind the ear, but such techniques have been inconvenient or inconsistent, or both.